<!DOCTYPE>
<html>
   <head>
       <meta charset="utf8">
       <meta name="viewport" content="width=device-width, initial-scale=1">
       <link rel="stylesheet" type="text/css" href="__PUBLIC__/css/bootstrap.min.css">
       <link rel="stylesheet" type="text/css" href="__PUBLIC__/css/signin.css">

       <script type="application/javascript" src="__PUBLIC__/js/jquery-1.11.1.min.js"></script>
       <script type="application/javascript" src="__PUBLIC__/js/bootstrap.min.js"></script>
       
       <title>水产品质量溯源系统</title>
   </head>
<body>
    <div class="container">
 <form  name="shenbao_form"  class="form-horizontal" role="form" method="post" onsubmit="return checkSubmitShenBao()" action="{:U('SubmitShenBaoGuZhang/submitshenbao')}">
    <fieldset>
      <div id="legend" class="">
        <legend class="">注册</legend>
      </div>
         <div class="form-group">
            <label for="firstname" class="col-sm-2 control-label">认证账号</label>
            <div class="col-sm-10">
               <input type="text" class="form-control" id="firstname"  name="account" 
                  >
            </div>
         </div>
         <div class="form-group">
            <label for="firstname" class="col-sm-2 control-label">姓名</label>
            <div class="col-sm-10">
               <input type="text" class="form-control" id="firstname" name="name"  
                  >
            </div>
         </div>
        <div class="form-group">
          <label for="name" class="col-sm-2 control-label">所在楼栋</label>
            <div class="col-sm-2">
            <select  id="Are003" name="Are003" tip="区域类型" class="form-control" >
              <option value="-100" selected="selected">请选择区域类型</option>
                <option value="1">学生宿舍区</option>
                <option value="2" >教工宿舍区</option>
                <option value="3">办公区</option>
              </select>
            </div>
            <div class="col-sm-2">
            <select name="Bui003" id="Bui003" tip="所属区域"class="form-control">
                <option value="-100" selected="selected">请选择区域</option>
            </select>
           </div>
           <div class="col-sm-2">
             <select name="Rec006" id="Rec006" tip="所在楼栋"class="form-control">
                <option value="-100" selected="selected">请选择宿舍楼栋</option>
            </select>
          </div>

        </div>
         <div class="form-group">
            <label for="firstname" class="col-sm-2 control-label">房间号</label>
            <div class="col-sm-10">
               <input type="text" class="form-control" id="room" name="room"
                  placeholder="请输入房间号">
            </div>
         </div>
          <div class="form-group">
            <label for="firstname" class="col-sm-2 control-label">联系电话</label>
            <div class="col-sm-10">
               <input type="text" class="form-control" id="tel" name="tel"
                  placeholder="尽量短号,方便联系,谢谢">
            </div>
         </div>

         <div class="form-group">
         </div>
      
      <div class="form-group">

            <label for="Rec009" class="col-sm-2 control-label">故障现象选择</label>
            <div class="controls col-sm-10">
              <select class="form-control" name="Rec009" id="Rec009" tip="故障现象选择" >
                  <option value="-100">请选择故障现象</option>
                  <option value="1">显示本地网络电缆被拔出（红色叉）</option>
                  <option value="2">网络连接正常，客户端认证失败（填写提示消息）</option>
                  <option value="9">客户端认证成功，但本地连接错误（黄色叹号）</option>
                  <option value="10">客户端认证成功，只能上QQ</option>
                  <option value="8">认证成功，不能访问任何网站</option>
                  <option value="4">IP地址绑定错误</option>
                  <option value="5">MAC地址绑定错误</option>
                  <option value="3">提示已达到同时在线用户数量上限</option>
                  <option value="6">用户不能使用该公共服务</option>
                  <option value="7">未规范使用网络, 请与管理员联系</option>
                  <option value="0">其它（请填写故障现象、锐捷客户端提示信息）</option>
          
                </select>
            </div>
        </div>

        <div id="reason" class="form-group hide" >
           <label for="Rec010" class="col-sm-2 control-label" style="color:red">请填写故障原因</label>
           <div class="col-sm-10">
              <textarea id = "Rec010" name="Rec010" class="col-sm-10" ></textarea>
           </div>
        </div>

        <div class="form-group">
          <!-- Text input-->
          <label for="firstname" class="col-sm-2 control-label" >方便上门维护时间段</label>
          <div class="col-sm-10">
            <input type="text" placeholder="请输入时间段" class="form-control" id="time" name="Rec011">
          </div>
        </div>
         <label class="control-label col-sm-offset-2" for="input01" name="time">保障时间: {$time} </label>
         
    <div class="control-group">

          <!-- Button -->
          <div class="controls col-sm-12 text-right" style="padding:0px;margin:0px">
            <!-- <button class="btn btn-success">提交</button> -->
            <input type="submit" id="submit" class="btn btn-success" value="提交"/>
          </div>
    </div>

          
    </fieldset>
  </form>
    </div> <!-- /container -->
  </body>
</html>



   
